Provider Demographics
NPI:1427305796
Name:PENA, MARIA LUISA (DDS)
Entity type:Individual
Prefix:
First Name:MARIA LUISA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9066 SW 73RD CT APT 910
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2968
Mailing Address - Country:US
Mailing Address - Phone:305-989-2296
Mailing Address - Fax:
Practice Address - Street 1:9565 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6943
Practice Address - Country:US
Practice Address - Phone:954-575-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 199091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice